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Cognitive Behavioral Therapy

Cognitive Behavioral Therapy

Intermittent Explosive Disorder

Intermittent Explosive Disorder – More Than Just Anger

Intermittent Explosive Disorder (also called IED, that is appropriate as it can go off unexpectedly and cause significant damage)

Intermittent Hulk Explosive DisorderProbably everyone knows that teenage boy (or girl) who punched a hole through the wall.  Perhaps for some, this became a regular pattern of behavior during adolescence but most of those teenagers outgrew it.  In fact, at least one-quarter of teenage boys has done something dumb like punching a wall.

One boy I knew in high school even broke his hand by punching the roof of his car, and some boys were routinely doing stupid stuff.  Despite that, all of it was teenage angst and changes that can be attributed to the massive amounts of testosterone flowing through the male adolescent body – none of them had intermittent explosive disorder.

Intermittent Explosive Disorder is worse than punching a hole through a wall.

It typically is first identified in the early teens – but can be seen much earlier in some cases.    In order to be actually characterized as intermittent explosive disorder, an individual must have had three episodes of explosive behavior that is severely out of proportion to the stressor.

Intermittent Explosive Disorder HulkinsectThey must have broken or smashed something that is monetarily valuable (more than a few dollars), physically attacked or made explicit threats to attack someone with the intent of causing harm.  If these three episodes occur within the space of 12 months, the disorder is considered to be more severe.

Here is the catch.

How do you distinguish between IED, average – though extreme teenage behavior and other psychiatric conditions?  It turns out that IED is probably a diagnosis of “if nothing else fits” as other psychiatric disorders certainly overlap with similar symptoms – and you have to rule out the adolescent hormone issue.

Bipolar disorder may cause outbursts of extreme anger and agitation, Borderline personality disorder may cause outbreaks, ADHD patients can exhibit a severe lack of self-control, and drug abuse is always a potential cause.  Even though those diseases may cause IED-like events, a sustained behavior pattern is something to address.

Intermittent Explosive Disorder WarningA recent study reported by the National Institutes of Health shows that IED can actually affect up to 4 percent of adults and lead to an estimated 43 attacks over a lifespan.  The disorder may also increase that chance of depression, anxiety and substance abuse disorders.  People with IED have an obvious increased risk of legal trouble, financial difficulties, and divorce – that’s a no-brainer.

So the biggest problem for mental health professionals, like many other disorders, is to untangle all of the information leading in and out with a mix of behaviors and a mix of causes.  What came first – the chicken or the egg?  What came first – the drug abuse or the anger?  Which illness is more important – bipolar disorder or the IED?

One of the biggest clues may be in examining (or better, paying attention to) behavior that occurs before puberty.  In other words: What came first – the behavior or puberty?  Clearly if the behavior started before puberty, there was and is an issue.  If the behavior begins during adolescence – you have to wait (and hope) to see if the behavior goes away once the hormones are settled.

IED is not a simple diagnosis.

It requires a careful examination of an entire psychiatric and behavioral history – and the “ruling out” of a lot of other disorders that may be to blame.  Unfortunately, in the end – unless an underlying cause can be found, there is no medicationAnger management and cognitive behavioral therapy are likely the only answer – minimization of harm, not very satisfactory if it was your car window that got smashed in a fit of rage.

Melissa Lind

Borderline Personality Disorder or Traumatic Stress Disorder

Borderline Personality Disorder – What if it is a traumatic stress disorder?

When most people think of Borderline Personality Disorder – they think of bad behavior.  It is someone that is very difficult to deal with, someone that you have to be on guard against, Borderline Disordersomeone who will try their best to manipulate you.
But, while that may be the outcome, just like most psychiatric disorders, it isn’t exactly their fault.

One of the problems with BPD is that since it is a “personality disorder“, there is often no recognized medical treatment.

We simply expect that the patient should self-monitor and control their behavior.  Therapy may help this, but how many of us (psychiatric patients, in general) really want to go to therapy.

Many of us have already spent hundreds of hours with a therapist – who may or may not help.  In addition, the best therapists are likely people who can “see through the bullshit” and refuse to be manipulated.  This obviously goes against the nature of someone with Borderline Personality Disorder.

In fact, the stigma is so bad that some therapists won’t even work with Borderline patients.

Co Morbid DisordersOne theory may help.  Some therapists have developed an automatic assumption that a Borderline patient is also a trauma victim.  While this co-morbid condition may not always be true, it can help some therapists feel more comfortable treating the patient.

Due to many soldiers returning from impossible battlefields in the Middle East, Post Traumatic Stress Disorder is fairly well recognized.  Remember; I am not saying that it is easily treatable, but to some extent, the stigma is less.

When therapists look at Borderline patients as truly a PTSD patient, they may be more willing to treat the disorder. And they will attempt to get to the underlying causes of abandonment, impulsive and destructive issues, loss of control and poor self-image.

While PTSD is well defined by the professional psychiatric community, a longer-term disorder currently known as complex traumatic disorder is not.  Most examples of CTSD still involve soldiers, or they may involve women who had difficult pregnancies or who were violently sexually abused, repeatedly.

However, what if you don’t fit any of those recognized categories?

There are more ways to treat traumatic stress disorders such as Cognitive Behavioral Therapy or a newer one, Dialectical Behavior TherapyDBT focuses on four major areas:

•    Regulation of emotionsPost-Traumatic Stress Disorder
•    Tolerance for distress
•    Interpersonal effectiveness
•    Mindfulness

Unlike CBT, there is no “processing” component – making it work well as an initial treatment, starting before the patient has developed coping skills.  It builds up the feeling of emotional safety so that coping skills may develop.

Differentiating between “plain” Borderline patients – and those whose behavior is brought on by traumatic experience may help to eliminate some of the stigma still associated with BPD.  It may also offer actual, more effective treatment than CBT or other approaches.

Melissa Lind

Panic Attacks and Anxiety

Suffering from anxiety disorder and have panic attacks?

Do you have anxiety?
Are you constantly worried?

We all probably know that anxiety is a normal part of life.  That horrible feeling of anxiousness is something that can happen to all of us from time to time — and with good reason. However, many people suffer from anxiety without any valid reason — regardless of how correct the reason for the anxiety seems to them.

Anxiety can cause a host of other mental health problems.
Child AnxietyFirst, when the brain is stressed, the body’s immune system fails to function properly. Things like this leads to illnesses. Second, anxiety can prevent one from living life to the fullest. And, finally, stress can lead to full-blown anxiety attacks, otherwise known as panic attacks.

A panic attack might feel like a heart attack. In fact, when one suffers their first panic attack, this is what they think that it is, in most cases. They will usually seek out medical emergency services. A lot of the symptoms are often the same as a heart attack. The person may feel chest pains, have trouble catching their breath, become dizzy, feel nauseous, and also feel completely out of control.

AnxiousLuckily, you won’t die from a panic attack — even though you can’t be convinced of that when it is happening. Even better news is that panic attacks can be prevented. Medication can be prescribed, relaxation techniques can be used, and counseling, in the form of Cognitive Behavioral Therapy (CBT) can be sought.

Your doctor will most likely prescribe an antidepressant for your anxiety. However, antidepressants take about three weeks to become effective, and during this time, you may discover that you are more anxious than you were before. Panic attacks may become more severe during this time.

For reasons mentioned, your doctor may also prescribe a benzodiazepine. The benzodiazepine will effectively take care of the anxious feelings, and help to prevent panic attacks. However, this is not a safe long-term drug, as antidepressants are. Therefore, after about three weeks, your doctor will most likely discontinue the benzodiazepine, and continue with the antidepressant. Naturally, CBT will also be recommended.

Panic attacks are very real — and very scary. If you suffer from panic attacks, know that there is treatment out there, and with that treatment, you can avoid future panic attacks.

Stress and Anxiety – Is There Any Relationship? (Free PDF)

Panic attacks and anxiety disorder sufferers

Obsessive Compulsive Disorder – OCD

Collecting, Organizing, Checking, Washing…. Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder.

OCD - Bug ObsessionIt is composed of two parts: Obsession and Compulsion.  Obsession is the portion of OCD that occupies your thoughts such as excessive concerns about cleanliness (my kids call this germophobia), extreme social fear, fear of harming someone, preoccupation with organization or other intrusive thoughts that create anxiety.  Compulsion is the physical manifestation of needing to do something about the obsessionsCompulsion results in behaviors such as ritualistic behaviors like excessive hand washing, repeatedly checking to make sure the stove is off, counting steps and other extreme behaviors such as hoarding.

OCD the Good
Once I while participating in a wedding, I was attending the rehearsal dinner at the home of the bride whose mother made the appetizers for over 200 people.  I was amazed at her management skills that made her capable of preparing appetizers from a single kitchen – right up until the time that when looking for the restroom adjacent to the laundry, I opened the pantry door.

There, staring at me were over 100 spice containers, of all the same brand, all the same size and all angled at a precise 45-degree angle so that the labels were all pointed exactly at my head.  I was so dumbfounded that I continued to stare and found that on the other shelves there were precise pyramids of 5 cans each of various vegetables – all the same brand, all the same size, with all the labels facing exactly the same direction.

Lining the floor were plastic bins, spaced 2 inches apart…exactly, containing 3 bags each of a variety of pasta, flour, rice…. all of course the same brand, carefully placed in the bin, with the label in exactly the same location.

This is OCD at its best – at least for others.  She had an obsession and a compulsion that created this superbly organized pantry.  Likely though, even this “good” OCD manifestation took up a lot of her time – and had a negative impact on her daily life and that of her family’s.

OCD is not always at its best however and can result in the opposite – hoarding.  I don’t have to go into this but if you haven’t seen it, you should watch “Hoarders” or “Hoarding, Buried Alive” for some insight.

OCD the Bad
In addition to situations like hoarding, OCD can also interfere with life in other ways.  I have a cousin with OCD, who before he was medicated, found himself unable to leave his driveway due to fears that he would back over a child with his car.  This caused him to spend hours – literally hours every morning starting the car, looking in the rear view mirror, getting out of the car to look behind it, getting back in the car, looking in the rear view mirror, getting out of the car….  He eventually found himself unable to work.

Obsessive Compulsive Disorder - OCD Confused MindOthers have found that OCD has limited their lives in similar ways.  Howie Mandel, a well-known comic, has talked about his Obsessive Compulsive Disorder.  It prevented him from appearing in public for many years, in part due to social fear but also due to fear of infection.  Even today, while his disease is “under control,” he does not ever shake hands or allow others to touch him.

How do I know if I have OCD?
A lot of people have rituals – such as specific routines before bed.  A lot of people have extreme concerns which may consume thoughts for a while – such as excessive concerns over money.  The difference in “normal” rituals and “normal” concerns is that they don’t typically impair normal life and they don’t become paralyzing.

Thoughts and behaviors that might indicate OCD:
•    Repeated thoughts or mental pictures about things such as
o    Germs
o    Dirt
o    Intruders
o    Violence
o    Hurting others
o    Embarrassment
o    Disorganization
o    Religious beliefs
•    Repeated behaviors such as:
o    Washing hands
o    Disinfecting surfaces
o    Locking and unlocking doors
o    Counting
o    Repeating steps over and over
o    Keeping unneeded things
o    Excessive grooming
•    Lack of ability to control or stop unwanted thoughts and behaviors
•    Repeated behaviors provide temporary relief from anxiety that is caused by obsessive thoughts
•    Repeated behaviors don’t provide any pleasure other than temporary relief
•    Spending at least 1 hour a day on thoughts and behaviors, creating a negative impact on daily life

The International OCD foundation reports that it takes around 15 years for most people to be diagnosed.  This may be due to hiding of symptoms – but it may also be due to lack of awareness of both the public and health professionals.

What can be done about OCD?
OCD can be treated – it usually cannot be cured but can be controlled.  First line treatment for OCD includes working with a properly trained therapist – most beneficially, one who is trained in cognitive behavioral therapy (CBT).  CBT uses “exposure to” unpleasant stimuli, carried on to the “what if” stage.  “What if” I touch that faucet without disinfecting it?  “What if” I get into the elevator without opening the door 10 times?  The “exposure” period is followed by “response prevention” where the patient chooses NOT to perform the behavior that the “exposure” usually causes.  Over time, the obsession and compulsive thoughts and behaviors become more manageable.
In other cases, medication may be needed – usually given in combination with CBT.  Some antidepressants (not all) will help with OCD.  Anti-depressants that have been shown to help include:
o    Luvox (fluvoxamine)
o    Prozac (fluoxetine)
o    Zoloft (sertraline)
o    Paxil (paroxetine)
o    Celexa (citalopram)
o    Lexapro (escitalopram)
o    Effexor (venlafaxine)

Other medications may also help but have not been “approved” to treat OCD.  Doctors who have found them helpful may use them regardless of whether they are officially approved to treat OCDMedications such as Cymbalta (duloxetine) have been reported to be helpful – and some patients may benefit from short-term use of anti-anxiety agents.

It is important to know that all medications may cause side effects and you should tell your doctor about any other medications you are taking.

Melissa Lind

Obsessive Compulsive Disorder (OCD) is a mental disorder characterized by intrusive thoughts that produce anxiety and by repetitive behaviors aimed at reducing that anxiety.

Obsessive Compulsive Disorder can be treated!

Online Counseling for Anxiety

Anxiety Counseling Online

Technology has made life better for all of us in a multitude of ways. We are able quickly to communicate with people around the world — without incurring huge long-distance bills. We are able to send and receive letters (email) and pictures instantly. We can bank and pay our bills online — and we can even seek counseling online.

Anxiety Counseling OnlineThere are several reasons one might seek counseling for anxiety online, instead of traditional counseling. Online counseling may be cheaper than the offline counseling. Of course, online counseling is often more convenient to the patient, as well.

Think about this. Someone who suffers from an anxiety disorder that prevents them from actually leaving their home to go to a counseling appointment may not get the treatment that they need — only because the problem prevents keeping the appointment — or possibly even setting up an appointment in the first place. Social anxiety is one such situation.

The most effective form of counseling for anxiety is Cognitive Behavioral Therapy, or CBT. This type of therapy teaches you to think differently — to look at and deal with problems or events in a more constructive way than an offline counseling. This type of counseling is available online and can be provided in groups or on an individual basis.

For online therapy, the therapist and patient can communicate in a number of different ways. These methods include email, instant messenger or chat, or even voice chat. Most online therapists will have several different means of communication available, and will work with the one that the patient prefers.

Most people find that online counseling is not only convenient, but also that it is quite effective — just as effective as an offline counseling — and that they actually prefer online counseling simply for the anonymity that it provides.
If you’ve avoided traditional counseling, you will most likely find that the things that you do not like about traditional counseling are avoided or resolved with an online counseling solution.


Talk to an Online Therapist via Skype for Effective Help with Anxiety, Panic Attacks, Depression, PTSD, Addictions & Relationships.

Counseling for Depression

Depression does require medication.

If you suffer from depression, and your doctor has prescribed an antidepressant for you, you will find that, in about three weeks, you are able to function in your life again — even while taking the medication.

Depression MedicationUnfortunately, this gives people a sense of “I’m all better now” that isn’t quite true. You see; depression does require medication, but it also requires counseling. Without proper counseling, you will never get to the root of the problem — what is causing the depression. The medication will not make that go away — it only deals with the symptoms of depression.

Counseling is needed to deal with the cause of the depression.

Counseling for depression may have two parts. The first part may be traditional therapy so that the counselor can help you to discover what the problem is, in the event that you do not already know. Sometimes depression has no visible cause. Other times, it may be caused by a physical condition that does not need any counseling at all — the depression lifts when the condition is treated.

So, traditional therapy may be needed, but that will usually be followed with Cognitive Behavioral Therapy, or CBTCognitive Behavioral Therapy essentially teaches you a new way of thinking — a new way of looking at or approaching a problem, — something that enables you to deal with the problem in a more constructive, timely manner. Once the problem that is causing the depression is taken care of, the depressed state lifts.

CBT can take anywhere from 12-20 weeks. Furthermore, depending on the severity of your depression, your doctor may not feel that counseling should be sought until the medication prescribed has a chance to work. On the other hand, he (or she) may think that the depression warrants immediate counseling. This varies from one individual to another.

Note that most therapists are not licensed to prescribe medication. That requires a medical doctor or a psychiatrist.